For many U.S. households, having healthcare is one of many priorities. Two years ago, “28.5 million people did not have health insurance”, and this was relatively unchanged from 2016, 28.1 million. The Affordable Care Act was designed to help address this issue, as well as, being responsible for lowering healthcare expenses.
Unfortunately, it had the opposite effect. Many cities and states are taking action to address the continual spikes in prices.
The Illinois Department of Insurance is hoping a new state bill will afford them a voice to “say no to certain sky-high price increases proposed by insurance companies for plans sold to individuals and small businesses.” I recently read “An American Sickness” by Elisabeth Rosenthal that outlines how many of these costs are being passed over to the patients. An average day in a US hospital “cost $4,300, which is ten times more than a stay in a Spanish hospital”
A story in The Atlantic describes a recent event where a local towns lady had a ministroke and was transported via ambulance for an overnight stay. This short one day visit cost her $26,203.62. With three-fourths of Americans not having at least a $1,000 set aside in an emergency fund, a bill of this size can be detrimental to household’s finances.
If you had such an extreme situation occur in your home, could you afford this bill? A study by KFF.org claims “about a quarter of U.S. adults ages 18-64 … had problems paying or an inability to pay medical bills in the past 12 months.” This is more common than you think.
If you are facing a situation with medical debt you can’t afford or need to understand these tips below to limit such financial devastation, here are # tips to reduce or minimize the effects of medical bills on your finances.
1. Check for Errors
Having billing errors are more common than you think. “Experts observed a 13 percent increase in medical costs and also found that more than 51 percent of patients owe $1,000 or more to their doctors”. As medical care becomes increasingly more expensive, medical billing becomes a larger focus area for healthcare. According to the CEO of Medical Cost Advocate, “80% of medical bills in the U.S. contain errors.”
If you have substantial medical bills, it has a 30-40% chance of having an error. Equifax claims that for every medical bill of $10,000, the average billing mistake amounts to approximately $1,300. Check for duplicated items, service or care not received or rendered, and charges your insurance should have covered.
Another reason to check for errors is a fraud. Having incorrect medical or personal information on your medical bills increases the chance of fraud which ultimately increases the change of your insurance company rejecting the claim.
2. Negotiate Your Medical Bill
With numerous clinics, practices, and hospitals switching from ICD 9 to ICD 10, there are nearly five times as many diagnosis codes for medical coders to learn and accurately input. This increases the chance of mistakes occurring, but if you do some research from a search engine, you can help decipher some of these codes to inquire if it is actually the service you received. Find out which service is legit and which isn’t accurate and call the billing office to correct the fees.
If you know you need a procedure performed before the operation or service, price shop. The world of healthcare knows the patients need to be more empowered. Ask for quotes in writing and what procedures will be performed, if possible. Double check to make sure these fees include any necessary ancillary services that may be required.
Next, ask for discounts. This may seem odd as if you are shopping at a thrift store, but some clinics offer 10% off if you can pay the bill over the phone or right away. Also, inquire if you qualify for the charity care program. Some clients have saved 30% after insurance coverage. The Charity Care Program is a program that “provides free or discounted care to uninsured and underinsured patients who are eligible for assistance.” To learn more about this program, visit AdvocateHealth.com.
The margin built between the delivery of care and its actual cost can vary widely. When a drug, Mesalamine, for example, sells for $12 in the United Kingdom, yet sells for over $700 in the United States, the price can be negotiated if you are polite and keep working on negotiating. While the ACA was designed to help shift healthcare from profits to focus on patients, it did little to reduce expenses. Plus, most hospitals have given authority to low-level admin personnel the ability to discount some bills by offering discounts.
Finally, contact the billing department and do not brush it off. It is recommended to visit the hospital’s billing department in person and sort it out. The staff is more likely to assist plus you can get an opportunity to discuss your financial situation one-on-one with a financial counselor. Nobody benefits if the bill can’t be paid and therefore, they will want to work with you to get paid.
3. Measures to Take Before Medical Visit
Do not be afraid to ask about more affordable options. When discussing matters with your physician, do not hesitate to ask how much treatment or visit will cost. As a patient, you have the right to know. Another question to ask is if specific tests are essential. For instance, ask the provider if a blood test, x-ray, CT scan, etc. are necessary to determine an outcome. Take the quotes and shop around to determine which provider is more affordable.
Another step to take is to determine if the treatments or practice are covered by your insurer’s network.
4. Check Yelp Reviews
Yep! Yelp has reviews on hospitals. It isn’t just for hotels and restaurants. The reports on hospitals can give one insight into the customer service, care of delivery, cleanliness, and much more.
5. How to Buy Cheaper Pharmaceuticals
a. Ask your doctor if there is a more affordable prescription or cheaper alternative.
b. Determine if a lower dosage is adequate and gets the same results, yet, saving money as it lasts longer.
c. Should around online and at drug stores. Sites such as GoodRx.com allows consumers to print coupons. You can save up to 80% on prescriptions.
d. Consider purchasing your pharmaceuticals outside the United States. This may come to a shock to many, but websites such as PharmacyChecker.com verifies if a foreign pharmacy is trustworthy. The FDA does not recommend this action as the federal drug watchdog cannot ensure its safety. However, the FDA does have a policy “explaining that it typically does not object to personal imports of drugs that FDA has not approved under certain circumstances” and you can read those at FDA.gov.
6. Decline Services not Covered by Your Insurance
You will need to do some homework on verifying what services your insurer covers. By knowing which medical services are not covered, you can decline specific tests at the time you’re being admitted. This is also when you are asked to sign documents. Paying attention to the “Limited Consent” clause, if you check this block, you are limiting services to only what is covered in your insurance network. You cannot be forced to undergo medical treatment unless it is a life-threatening emergency.
You have the right to consent to only what is covered by your insurer. By knowing which medical services you are covered, you can limit your medical expenses.
7. Medical Bill Forgiveness
Some situations occur where hardships are present such as disabilities that may keep one from working. If you are in this situation, you petition the “provider to forgive the debt entirely” 11, and this will likely require proof. This means to bring in your financial documents such as latest pay stub or unemployment documents to tax returns. There are a few non-profit foundations that may be able to assist. Contact PAN Foundation and CancerCare for assistance.
8. Debt Consolidation
While this is usually the last recommended step, there may be moments that warrant consolidating your level into a secure and manageable monthly payment. Before you apply, tally up your debts and determine how long it will take to pay off your debts and how much you currently owe. Lastly, you must know how much is a reasonable but affordable amount for you to pay.
In a country with complicated medical billing, the payer bears “full legal responsibility for the medical bills”, and it is causing severe financial problems in U.S. households. By learning and understanding your insurance coverage, you will gain the knowledge and tools to interpret and adequately dispute a bill should the need arise. Seeking out lower medical expenses is a tough feat as one needs to face not only the providers and staff, but also the insurance company as well. Remember to negotiate your bill while being polite. The medical staff is willing to work with you and will do everything in their ability to cut fees where they can. Also, you should ask about any available payment plans that may be available that can be structured into affordable monthly payments. If you do not have insurance, ask about special discounts and programs that may be available.